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Description of teaching and training programmes

Training in anaesthesiology involves the peri-operative management of elective and emergency cases under the supervision of a Consultant Anaesthesiologist. The specialist : registrar ration is approximately 1: 2. The amount of clinical independence increases as the trainee advances during their training period. A logbook of anaesthetic procedures performed is kept by the trainee on a RedCap Database hosted by the department.

Trainees are taught the principles and practice of general, regional and local anaesthesia.  Techniques include the use of both intravenous and inhalational agents, and open and closed circuit anaesthesia.  The need for proper record keeper and a high level of monitoring (including invasive haemodynamic monitoring) are stressed. Adverse events are also logged on the RedCap database.

During their training period, registrars are exposed to the types of cases/techniques listed below.  This list is by no means exhaustive but services to indicate the scope of exposure. The registrars’ logbook would provide specific cases and duration of exposure unless specifically designated rotational. The types of procedures performed and to which the registrars are exposed, include:

Orthopaedic Surgery

Analgesia and anaesthesia for fractured spine (cervical, thoracic, and lumbar), correction of spinal deformities, major long bone fractures, and joined replacements.  Anaesthesia for paediatric Orthopaedic management is also provided (see paediatrics).

Obstetric Anaesthesia

Analgesia and anaesthesia for the pregnant patient (including intravenous, inhalational, spinal and epidural techniques), management of obstetric emergencies (including ante-partum/post-partum haemorrhage, manual removal of placenta), and management of maternal complications (including pregnancy induced hypertension and eclampsia).  The department manages approximately 30 000 deliveries a year, with a caesarean section rate of 30-40%.  Approximately 85% of Caesarean Sections are currently carried out under regional block, but a trainee would be expected to have completed at 40 Caesarean sections under general anaesthesia.  A senior registrar serves as senior anaesthetist on site for out-of-hours emergency Obstetric and Gynaecological anaesthesia. 

Gynaecological Surgery Anaesthesia

Anaesthesia for laparoscopy, hysterectomy (sub-/total abdominal/vaginal), gynaecology oncology (including pelvic clearance), evacuation of retained products of conception, gynaecological minors and ectopic pregnancies.

Paediatric Anaesthesia

Anaesthesia for all aspects of paediatric surgery, including general surgery, ENT, orthopaedics, neurosurgery, spinal, plastic and reconstructive surgery, and neonatal emergencies such as trachea-oesophageal fistula, omphalocele,  congenital diaphragmatic hernia, pyloric, stenosis and necrotizing enterocolitis.  Resuscitation of neonates, post-operative analgesia and outpatient anaesthesia also form part of training.  A senior registrar will provide anaesthesia for our of hours emergency neonatal surgery, as well as render assistance in neonatal resuscitation at Caesarean section.

Cardiac Anaesthesia

Anaesthesia for cardiac surgery with and without cardiopulmonary bypass for patients with acquired heart disease (including coronary artery bypass grafting, valvotomy/valve replacement, pericardiectomy, and thoracic aneurysm) and congenital cardiac abnormalities (including atrial and ventricular septal defects, patent ductus arteriosus, Fallot’s tetralogy, and coarctation of the aorta).  An exposure to Cardiac ICU is also mandatory, primarily for post-surgical patients, but also for optimization of severe cases.  This is done at the Charlotte Maxeke Johannesburg Academic Hospital by all our registrars on a rotational basis, for a minimum of 3 months. 

Thoracic Anaesthesia

Anaesthesia for mediastinoscopy, bronchoscopy, endoscopic surgery, tracheal resection, pneumonectomies’, lobectomies, and resection of emphysematous bullae.  This is done at the Charlotte Maxeke Johannesburg Academic Hospital by all our registrars on a rotational basis, for a minimum of 3 months. 

Neurosurgical Anaesthesia

Anaesthesia for intracranial haemorrhage, aneurysms, arteriovenous malformations, removal of cerebral, pituitary and posterior fossa tumours, insertion of ventriculo-peritoneal shunts, closure of spina bifida.

Acute and chronic pain control

Management of cases with oral and intravenous analgesics, sedatives, antidepressants, local, epidurals, spinals, coeliac plexus, stellate ganglion, lumbar sympathetic, intrapleural blocks (with anaesthetic agents, steroids and alcohol), and TENS.  Chronic pain clinic exposure is on a rotational basis at Helen Joseph Hospital. 

Urological Anaesthesia

Anaesthesia for open and closed prostatectomies, urolithiasis, nephrectomies, cystectomies, ileal conduits, and lithotripsy.

Plastic and Reconstructive Surgery

Anaesthesia for major plastic repair trauma case, re-implantation of limbs, free flaps, and cosmetic surgery including cleft palate repair.  The department serves as a group of major referral centres for burns cases.

Maxillofacial and Dental Surgery

Anaesthesia for mandibular and maxillary surgery, including osteotomy, mandibulectomy or advancement, wiring or internal fixation, and outpatient dental anaesthesia.


Anaesthesia for airway surgery, including laryngoscopy and biopsy, laryngectomy, tracheostomy, surgical or laser resection of tracheal stenosis and polyps, glossectomies, removal of tumours and foreign bodies.  Registrars are also trained in the management of epiglottitis and croup, and ear and nasal surgery,


General anaesthesia for numerous procedures on all types of patients including paediatric and geriatric patients.  This includes anterior and posterior chamber work.

General surgery, transplantation, trauma and emergency surgery

Includes hepatobiliary, pancreatic, colorectal, oncology, minor general surgery and anaesthesia and resuscitation of the polytrauma patient.  Trauma exposure includes penetrating injuries (stabbings and gunshots) as well as road traffic and occupational accidents.  Renal transplantation anaesthesia is done during rotation to the Charlotte Maxeke Johannesburg Academic Hospital.  Senior Registrars are also involved in the DGMC Liver Transplantation Program, with consequent exposure to Liver transplantation anaesthesia.

Vascular surgery

Anaesthesia, both regional and general, for the treatment of vascular disease including aortic aneurysm, carotid endarterectomy, re-vascularisation procedures (e.g. fem-pop bypass) and repair of traumatic vascular injuries. 

Remote Anaesthesia

Out-patient/procedural anaesthesia for imaging at computerized tomography, magnetic resonance imaging, renal biopsy and other minor surgical procedures/investigations (incl. gastroscopy, colonoscopy) are provided.

Simulation in Anaesthesia

High fidelity anaesthesia simulation is a very integral part of our training as it avails options to us that may not be feasible particularly during COVID (figure 5). The limitation in simulation manikins and other equipment of interest in anaesthesia limit this very important component of our training platform. We have however continued to use what is available to us with great success. The department also conducts hands on skills training such as the FATE ultrasound course.

Figure5. Simulation in Anaesthesia

Training in critical care

This occurs on a rotational basis at Chris Hani Baragwanath Academic Hospital, Charlotte Maxeke Johannesburg Academic Hospital and Wits Donald Gordon Medical Centre.  This is accomplished though 3 months at CHBAH or CMAH and 3 months at DGMC.

The Units have consulting obligations in other areas, including ventilated and critically ill patients held in general wards and for whom no bed is available in the unit itself. Regular medical admissions include patients requiring ventilator and other organ support due to drug overdose, asthma, Guillain-Barre, pneumonias, etc. Surgical conditions include those of major vascular surgery, intra-abdominal and other overwhelming sepsis, multiple organ failure, etc. A wide variety of polytrauma caused by motor vehicle accidents, gunshots and other forms of violence is admitted to the unit.